Coding Services Technology Auditor

Cedars-Sinai Medical Center•Los Angeles, CA

11d

About The Position

The Coding Auditor works under the general direction of the Coding Supervisor and reviews encounters in prebill or retrospective workflows to validate coding profiles. Reviews cover applicable code sets for encounter type, abstracted data elements, missed query opportunities, and other encounter data collection points. The auditor evaluates compliance with internal coding policies and procedures, coding handbooks, AHA and AMA references, and local, state, and federal coding guidelines. The role performs quality coding reviews and audits to departmental productivity and accuracy standards; helps process rebills following audit changes and coding corrections requested by the billing department; and prepares written summaries of findings. The auditor coordinates and leads individual and small-group feedback and education sessions, facilitates roundtable discussions, contributes to the coding newsletter, and provides basic trending and data reviews. The role also evaluates codes using data reports and trended opportunities, validates findings through audits, and recommends action plans. The auditor maintains communication with internal and external stakeholders and peer departments, including Coding Operations, Clinical Documentation Integrity, Payor Revenue Management, and Compliance Revenue Integrity. The role may assist peer departments with production coding during staffing shortages and perform additional activities, such as data quality reports, as assigned by the Coding Supervisor. This work supports data quality for reporting and research, accurate billing and reimbursement, and quality of patient care.

Requirements

High school diploma or GED required.
At least 3 years of Coding Audit experience, with auditing skills covering coding and billing accuracy of coding staff, required.
One of the following credentials is required upon hire: Certified Coding Specialist-Physician (CCS-P), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT).

Nice To Haves

Associate degree or college diploma in health information management preferred.
Bachelor's degree in health information management preferred.

Responsibilities

Review encounters in prebill or retrospective workflows to validate coding profiles, including applicable code sets, abstracted data elements, missed query opportunities, and other encounter data collection points.
Evaluate compliance with internal coding policies and procedures, coding handbooks, AHA and AMA references, and local, state, and federal coding guidelines.
Perform quality coding reviews and audits within departmental productivity and accuracy standards.
Assist with processing rebills following coding audit changes and with coding corrections requested by the billing department.
Prepare written summary reports of audit findings.
Coordinate and lead individual and small-group feedback sessions based on recommendations.
Maintain open communication with internal and external stakeholders and peer departments, including Coding Operations, CDI, PRM, and CRI.
Assist peer departments with production coding during staffing shortages.
Provide individual and small-group education sessions, facilitate roundtable discussions, contribute content to the coding newsletter, and provide basic trending or data review.
Evaluate codes using data reports and trended opportunities, audit to validate findings, and produce summary reports with recommended action plans.
Perform additional activities, such as data quality reports, as assigned by the Coding Supervisor.
Support data quality for reporting and research, accurate billing and reimbursement, and quality of patient care.